Celiac.com 01/22/2009 - Is celiac disease sidelining the cherished CEO of one of America's iconic companies?

Recent news that Apple CEO Steve Jobs will be stepping down from his duties, at least temporarily, has fueled speculation both online and in mainstream media about both his condition and his prognosis, in addition to sending Apple shares tumbling downward.

Jobs announced in early January that he was suffering from a "hormone imbalance that has been robbing [him] of the proteins [his] body needs to be healthy," and which has led to dramatic weight loss. The announcement stated that Jobs' condition was due to a "nutritional problem" for which treatment is "relatively simple and straightforward."

Apple announced in mid-January that Jobs was taking medical leave through June. The SEC recently announced that it will undertake a review to ensure that investor notification of the health disclosure was timely and forthcoming. Still, the larger question remains: What ails Steve Jobs, and how will it effect Apple?

A number of people have speculated that Steve Jobs might be suffering from the effects of untreated celiac disease. Type the terms "Steve Jobs" and "celiac disease" into Google and you will get about 7,000 results.

In his piece in the Motley Fool, Tim Beyer notes that, according to sources cited by The New York Times, Jobs is suffering not from a recurrence of pancreatic cancer but from a condition that is "preventing his body from absorbing food." Beyer goes on to state: "I've said before that his condition sounds like celiac disease and I still believe that."

Jobs underwent an undisclosed procedure for a pancreatic tumor in 2004. Whipple surgery,  a common treatment for Pancreatic cancer, involves removing portions of the stomach, pancreas, bile duct and small intestine, and can interfere with digestion and nutritional uptake, even years later.

However, more than one doctor has pointed out that Jobs' description of the condition seems a bit confusing. Dr. Robert Lustig of UCSF Medical Center says that the statement "doesn't make a lot of sense." He goes on to point out that "[t]here are three medical threads that run through this e-mail, but unfortunately those threads don't make a very strong cable."

When asked if celiac-related hyperthyroidism might be explain Jobs' symptoms, Dr. Lustig noted that celiac disease does interfere with the body's ability to uptake nutrients, but that celiac disease is a digestive order, not the result of a hormone imbalance. Moreover, there is no single condition wherein a hormone imbalance and protein deficiency can be treated with a simple dietary change.

Still, thyroid problems, both hyper- and hypothyroidism are common in people with celiac disease. Untreated celiac disease can cause intestinal damage, and prevent proper absorption of nutrients, including protein, leading to weight loss. Hyperthyroidism can cause hormone imbalance.

When asked if it was possible that Mr. Jobs' explanation had conflated two conditions, celiac disease, which would rob his body of proteins, and would also require a "nutritional therapy," together with hyperthyroidism, which would cause a "hormone imbalance," Dr. Lustig conceded that such a scenario was possible, but he declined to speculate upon the likelihood.

Dr. Lustig did point out that even if celiac disease and hyperthyroidism were at the root of Mr. Jobs' symptoms, that "neither celiac nor hyperthyroidism has anything to do with his previous pancreatic chromaffin cell tumor."

However, such a scenario would certainly dovetail with Jobs' statement, and would also explain the relatively "simple and straightforward" nature of the treatment; even related hyperthyroidism would be easily controlled with drugs (usually Methimazole).

In fact, if celiac disease and hyperthyroidism is at the heart of the problem, Mr. Jobs will likely face a very positive prognosis, as they are both treatable conditions. By following a simple course of drugs for hyperthyroidism, and by adopting a gluten-free diet for celiac disease, Mr. Jobs would be looking at a recovery period that would put him back in the saddle in just a few months, or around June, just the time he's scheduled to return to his duties at Apple.
  • Robert Lustig, M.D. is with the Division of Pediatric Endocrinology at UCSF, and speaks on behalf of the Hormone Foundation, which is the public outreach arm of the Endocrine Society.
  • Dr. Walter Willett is chair of the department of nutrition at the Harvard School of Public Health.
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